There were 153 kidney transplants in Ireland in 2019, similar to the number for the previous year, but in a significant change, 30% were for previously highly sensitised, “un-transplantable” recipients, according to the annual report of the National Kidney Transplant Service.
“The continued expansion of the highly sensitised programme was our greatest success at NKTS in 2019. This programme aims to find suitable kidney transplants for otherwise un-transplantable patients due to the presence of antibodies in their bloodstream. A total of 46 such highly sensitised patients were transplanted in 2019, almost a third of all activity, with one of the patients having been on dialysis for over 19 years.”
The number of patients alive with a functioning transplant has also continued to grow, the report said, reaching 2,577 at the end of 2019, a 2.7% increase from the previous year.
There was a 4.3% fall in the numbers on the waiting list, from 483 in 2018 to 462 in 2019. The median waiting time to transplant was 18 months, a slight improvement from 2018. Average waiting times for living donor transplants were shorter, at nine months, in 2019. “Nonetheless, the active waiting list at the end of 2019 remains two and half times larger than the supply of donor kidneys. A shortage of suitable organs for transplant remains a perennial challenge.”
The report said eight recipients had reached the 40th anniversary of their transplant, bringing to 15 the number of patients with a kidney transplant lasting over 40 years. Five paediatric transplants took place in the Children’s University Hospital, Temple Street. Dublin, with four from a living donor.
Of the 153 transplants in 2019, a total of 25 were from living donors and 128 were from deceased donor kidneys. While outcomes for living donors are similar to those for deceased donor transplants in the first year (95% and 100% transplant and patient survival respectively), the benefits of living donor transplant become apparent in subsequent years.
“At the five-year time point, living donors kidneys had a 91% graft survival and 97% patient survival probability compared to 86% deceased donor kidney transplant survival and 90% patient survival. In addition, patients who received a living kidney donor spent considerably less time waiting for a transplant and spent less time on dialysis, with a significant number avoiding the need for dialysis entirely. These outcomes highlight the enormous advantages of living kidney donation and illustrate why living donation should be the first choice for the majority of Irish patients.”
But despite these advantages, the uptake of living donor transplantation remained low. “We performed fewer living donor transplants in 2019 than in 2018, and were below our target of 50 living donor transplants for the year. This was despite evaluating our highest ever number of potential kidney donors, 12% more than in 2018. Unfortunately, the majority of those coming forward were medically unsuitable to proceed.